RENAL ASSESSMENT

Mr. Nikhil D Ketkar ( MSc Nursing )

Nursing caring for patients over time may observe subtle changes when performing physical
assessments. Relating the observed changes to the function of various body systems allow
prompt interventions. nurses need to correlate their knowledge of physiology to assessment
findings. This article will assist nurses in relating physical assessment findings to renal system
physiology.

Objectives
After reading this article, the reader will be able to:
1. List the structures and functions of the renal system.
2. Review the role of the renal system in maintaining homeostasis.
3. Describe physical assessment findings in relation to renal system physiology.

Assessment is a crucial part of the nursing process. A basic rule in nursing is to assess
patients before establishing appropriate interventions. After collecting data nurses must
correlate assessment findings with body system functions. This article focuses on basic physical
assessment findings related to the renal system.
Renal system function affects the entire body. This system is evaluated in part by the data
collected during physical assessment. Knowledge of anatomy and physiology provides a
necessary foundation for astute physical assessment. A review of the renal system structures and
functions is necessary before presenting renal assessment.

Renal System Structures and Functions

Kidneys. The kidneys assist in maintaining homeostasis in the body by adding and
eliminating various elements. There are special structures within the kidney called nephrons.
Each kidney has approximately 1.2 million nephrons. Two complex tasks are performed by the
nephrons: fluid and electrolyte balance, and waste product removal. Filtration, reabsorption, and
secretion of fluids and substances occur throughout the nephron's vascular and tubule
components. The ability to perform these functions enables the kidneys to assist in maintaining
homeostasis.
 The process of filtration starts as the blood enters the afferent arteriole, which begins the
nephron vascular segment. The afferent arteriole forms a capillary tuft called the glomerulus.
Each glomerulus is encircled by a Bowman's capsule. Hydrostatic, colloidal, and capsular
pressures exerted within the glomerulus and Bowman's capsule produce approximately 180 L of
filtrate per day. Only 1-1.5 L of filtrate is excreted as urine. If the glomerulus is intact, filtrate
dispensed into the Bowman's capsule should be free of red blood cells and proteins. The
Bowman's capsule is the beginning of the nephron tubule section. Depending on the body's needs
and presence of drugs, hormones, or diseases, selective reabsorption and filtration of substances
occur throughout the tubular segments: proximal convoluted, Loop of Henle, distal convoluted,
and collecting duct. Unnecessary elements and fluids remain in the tubules and are excreted as
urine. Vital…